Cost Minimization of Pre-Enrolment Investigations in Treating HCV Infected Patients

Background: A screening program was launched in Egypt in 2018, targeting adult population for HCV and hypertension, diabetes, and obesity. Objective: To assess the financial impact of reducing cost of pre-enrolment investigations before treatment allocation. Method: 6771 adult patients, recently diagnosed with anti-HCV antibody positive during screening campaigns were included. Scenario-1: patients were categorized into 2 groups; Difficult and Easy to treat. Scenario-2: Patients were categorized by Fib-4 score into 2 groups with score ≤3.25 and score >3.25. Costs of pre-enrolment data obtained from National Committee for Control of Viral Hepatitis (NCCVH) administrative records. Cost minimization (CM) analysis compared the 2 scenarios with incremental analysis in Egyptian pounds. Results: Direct medical costs of both scenarios, pre-enrolment costs, direct treatment costs in scenarios 1 and 2 were 2528 and 3866 L.E respectively. Total costs in scenario-1 is 18,536,706 L.E. Comparing the 2 scenarios, 502 patients would have discordant results of both scenarios. Based on 89% SVR response expected from chronic HCV patients in previous literatures, supposing 11% treatment failure in patients with discordant results, 55 patients would need retreatment with Direct antivirus agents (DAAs) with 24 weeks duration. Total cost of scenario 2 is 18,087,772 L.E. Incremental cost minimization analysis per patient is 66 Egyptian pounds (LE). Conclusion: In limited resources countries with high prevalence of HCV as in Egypt, cost minimization in pre-enrolment setting would be preferable.